BenefitPlanOver
The table contains overtime information from the benefit plan master file.
| Column Name | Type | Description |
|---|---|---|
| OverTimeBenefitPlanReportGrouperSixtyCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| ReportGrouperFortyEightCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| AllowTelehealthForLowUtilizationPaymentAdjustment | VARCHAR | Determines if a payer or plan considers telehealth visits as counting toward the LUPA threshold. |
| BenefitPlanContactComment | VARCHAR | The comment for this contact. |
| PatientDrivenGroupingsModelBillingSystemIdentifier | NUMERIC | This is the Home Health billing system used by this Plan to drive billing and claims functionality specific to PDGM. This can be set at the payor and plan levels. |
| BenefitPlanReportGrouperFiftySevenCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| BenefitPackageIdentifier | NUMERIC | The ID of the benefit package for this benefit plan. The name of the benefit package is in the column BEN_PACKAGE_NAME. |
| IsBillForDenialEnabledForHomeInfusion | VARCHAR | Indicates whether bill for denial is enabled for this plan in Home Infusion workflows. 'Y' indicates bill for denial is enabled. 'N' indicates it is not enabled. If NULL, then the payer-level setting is used by the system instead. |
| BenefitPlanReportGrouperFiftyTwoCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| LongTermCareMinimumDataSetEffectiveDate | DATETIME | This item indicates which MDS version the plan requires PPS assessments to follow. |
| OvertimeReportingGrouperFiftyOneCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| TieredBenefitPlanContactFlag | VARCHAR | Contact-level flag for a tiered benefits plan. |
| IsBenefitPackageReleasedIndicator | VARCHAR | Indicates if the Benefit Package and its corresponding Limit and Payment Parameters are ready to be used. |
| BenefitPlanContactType | INTEGER | Indicates the type of the contact for this benefit plan - initial entry or update. |
| BenefitPlanReportGrouperFortySevenCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| ReportGrouperFortyFour | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the free text report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| ReportGrouperFiftyCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| BenefitPlanContactEffectiveStartDate | DATETIME | The first date where the benefits of this contact of the plan could possibly be effective. |
| BenefitPlanReportGrouperFortyNineCategoryOverTime | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| ReportingGrouperFortyThree | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the free text report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| PhysicalDeploymentOwnerIdentifier | VARCHAR | ID of the physical deployment owner for this record. Physical owners will be where the data is hosted, either on the cross-over server or the owner deployment. |
| BenefitPlanContactLastEffectiveDate | DATETIME | The last date where the benefits of this contact of the plan could possibly be effective. |
| BenefitPlanReportGrouperFiftyNineCategoryOverTime | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| PlanFeeScheduleIdentifier | NUMERIC | The fee schedule for this plan. If a plan-level fee schedule is not specified, the payer-level fee schedule is used. |
| OvertimeReportGrouperCategoryFiftyThree | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| StateRequiresPatientDrivenPaymentModelForOmnibusReconciliationAssessmentIndicator | VARCHAR | This item indicates whether the state requires PDPM codes to be calculated for standalone OBRA assessments beginning October 1, 2020. |
| CapitationReconciliationRateFactor | NUMERIC | Stores the rate factor that is multiplied by the base rate to get the final expected rate for the member during the reconciliation process in Cap RR. |
| BillAllCoveragesForNonSkilledCareIndicator | VARCHAR | Indicates whether the plan is requiring that all previous coverages be billed sequentially even if those coverages won’t cover a non-skilled level of care. ‘Y’ indicates that this plan requires the other coverages to be billed. ‘N’ or NULL indicates that the other coverages don’t need to be billed. |
| BenefitPlanReportGrouperFortyFive | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the free text report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| BenefitPlanContactDate | DATETIME | The contact date of the benefit plan in standard date format. |
| BenefitPlanServiceIntensityAddonPaymentIndicator | VARCHAR | Determines if this benefit plan pays a Service Intensity Add-on for hospice claims. |
| BenefitPlanIdentifier | NUMERIC | The unique ID of the benefit plan. |
| MedicationFeeScheduleIdentifier | NUMERIC | The fee schedule to use when pricing an expensive medication. This fee schedule is checked first, before the plan's regular DBC fee schedule. If no plan-level fee schedules are specified, the payer-level fee schedules are used. |
| BenefitPlanReportingGrouperFiftySix | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| BenefitPlanIcdProcedureCodeSetCategory | INTEGER | The preferred ICD procedure code category number set for the plan. |
| BenefitPlanCategoryReportGrouperFiftyEight | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| ReportGrouperFortyTwoOverTime | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the free text report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| BenefitPlanReportGroupFiftyFourCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| ReportGrouperCategoryFortySix | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers that is over time. There are more report grouper columns in the CLARITY_EPP and CLARITY_EPP_2 tables that are not over time. |
| LogicalDeploymentOwnerIdentifier | VARCHAR | ID of the logical deployment owner for this record. Logical owners show the deployment where the record was created but doesn't represent if the record is a part of version skew. |